Even so, NIOSH recently identified 22 counties as "hot spots" for rapidly progressive black lung in four Appalachian states — Pennsylvania, Kentucky, Virginia and West Virginia. A handful of hotspots in Alabama and Colorado were also noted.
In these counties, some miners in their 30s, 40s and early 50s are experiencing rapidly progressive black lung — about 10 to 30 years sooner than cases observed in the past, Wolfe said.
Also, Appalachian miners at smaller operations (fewer than 50 employees) are more likely to develop advanced black lung, Wolfe said.
NIOSH researchers spotted the trends among miners screened from 1996 to 2002, and they're back in black lung hot spots — most recently eastern Kentucky — to X-ray more underground coal miners and gather additional details about their work and medical histories.
Last fall, a NIOSH study reported 886 cases of black lung, or coal workers' pneumoconiosis, among the 29,521 miners screened nationwide from 1996-2002.
The 3 percent prevalence of the disease indicated a significant decline in black lung cases compared to the 10 percent rate at the time the federal Coal Mine Health and Safety Act of 1969 was enacted.
Of the 886 miners with black lung, 783 of them had at least two X-rays that allowed researchers to determine how quickly the disease was progressing.
They found that 35 percent of the cases were rapidly progressive, meaning the scar tissue from coal dust exposure to the lungs was spreading about twice as fast as normal progression, said Dr. Vinicius Antao, who headed the NIOSH study.
While the percentages of severe and progressive black lung cases seem small, they indicate "inadequate prevention measures in specific regions," the study states.
Buchanan County, one of six Virginia hot spots, had the most miners with rapidly progressive black lung, with 60. Pike County, one of eight Kentucky hot spots NIOSH is revisiting in August, had 39.
Antao said the research suggests that "younger miners may be exposed to higher concentrations of dust" than their older counterparts have faced in the past.
"Somehow, there's inadequate dust control," he said. "Since we're having severe disease among younger miners, that means recent mining conditions or dust concentrations are high."
Mine safety experts said new cases of black lung may indicate a lack of thorough inspections, especially at small or contracted operations, and mine companies pushing to increase production to keep up with the rising demand for coal.
They also said the current amount of coal dust allowed in mines — 2 milligrams per cubic meter — may be too high to prevent the disease as initially intended.
"The bottom line is over exposure," said Dr. Bob Cohen, a Chicago pulmonologist who heads the National Coalition of Black Lung and Respiratory Disease Clinics. "It makes you wonder whether dust levels in these mines are controlled and the degree of enforcement out there. Are we really monitoring these mines carefully?"
Julius Michael Smith, a 49-year-old coal miner in eastern Kentucky, showed up this week at the NIOSH site in Pike County for a chest X-ray. He won't know the results for at least eight weeks, but he suspects he has black lung after 19 years on the job.
"Coal mines are not dust free," he said. "You have to produce coal. You can't operate 100 percent by the rules. You could, but you wouldn't make no money."
Steve Sanders, an attorney with the Kentucky-based Appalachian Citizens Law Center, has represented dozens of miners diagnosed with black lung over the past 20 years. Smith's claim is one Sanders has heard over and over: "It's partly because the regulations are not observed or enforced effectively."
Small operations, which make up about two-thirds of the coal mines in Appalachia, are often unfairly accused of neglecting safety standards, said Chris Hamilton, head of the West Virginia Coal Association. He said if dust exposure is a problem at these mines, then the adequacy of inspections by the U.S. Mine Safety and Health Administration should be questioned.
"They need to devote a greater amount of inspection time to those mines with poor safety records, regardless of mine size," he said.
Acting MSHA Administrator David Dye released a statement Tuesday, reminding coal operators of their duties to keep coal dust at the mandated level.
"Miners should not suffer from the devastating effects of black lung disease and we remind the coal mining industry that compliance with respirable dust standard is a continuing responsibility on every shift not just those shifts that are sampled by the operator and MSHA inspectors," he said.
Kentucky Coal Association President Bill Caylor stressed that the small percentages of black lung prove that the disease is fading and more research should be done before coal operators are blamed.
Whether the level of allowable coal dust is effective should also be examined, Sanders said. In 1995, NIOSH suggested the level be dropped to 1 milligram per cubic meter, but the change was not adopted by federal regulators.
For Connie Cline, a retired miner, such changes are too late. The 55-year-old began working in underground "mom and pop" operations in Buchanan County, Va., and parts of West Virginia in 1975 — six years after the federal regulations that should have protected him from black lung went into effect.
Though he spent only seven years underground, he said, he's been diagnosed with progressive massive fibrosis, the worst stage of black lung.
Cline said that as a young miner, he never thought he'd fall victim to black lung.
"I thought, 'That's not going to happen to me,'" he said. "I thought I hadn't been in the mines long enough to get black lung." |
